Provider Demographics
NPI:1427826635
Name:TUTTLE, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N 63RD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-2425
Mailing Address - Country:US
Mailing Address - Phone:402-890-9319
Mailing Address - Fax:
Practice Address - Street 1:2900 N 63RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-2425
Practice Address - Country:US
Practice Address - Phone:402-890-9319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider